“Voice your choice”: a study of women’s choice of surgery for primary stress urinary incontinence

Abstract

Introduction and hypothesis This was an observational study aiming to determine factors which influence women's choice of surgery for primary stress urinary incontinence (SUI). Methods Two hundred twelve women undergoing a primary SUI procedure were recruited to this study from 12 hospitals in the north of England. After choosing a procedure, women were asked to complete a standardized semi-structured questionnaire about their health, demographics and a free text box to record factors important to them when choosing their procedure. Statistical analysis was performed to determine the impact of demographic, lifestyle or healthcare factors on women's decision-making. Thematic analysis of the free text data was performed to identify factors important for women when choosing a surgical procedure. Results Sixty-four percent of women chose urethral bulking. There was no significant difference among age, BMI, smoking status or previous laparotomy between women choosing the four types of surgery. Women were less likely to choose urethral bulking if seen in a tertiary centre compared with a secondary centre (p < 001). Major themes in decision-making were efficacy, invasiveness, recovery, risk of complications, use of mesh, the clinician, the media, hierarchy of treatments and type of anaesthetic. Some women expressed a hierarchical approach to treatment. Conclusions Our findings suggest decision-making is not influenced by patient factors such as age, BMI, smoking status or previous laparotomies. Women's choices are a complex mix of factors and not simply related to efficacy.

Counseling for stress urinary incontinence in the era of adverse publicity around mesh usage: Results from a large‐sample global survey

“…It has been reported that patient concern about polypropylene mesh and the media's representation of mesh procedures are key factors in women's decision making. This likely explains why a significant proportion of our patients have a negative preconception of synthetic MUS 19 …”

“…This likely explains why a significant proportion of our patients have a negative preconception of synthetic MUS. 19 The mesh debate has significantly increased patient consultation times. There is evidence in literature that "consultation content" rather than "consultation length" positively impacts patient satisfaction.…”

A retrospective analysis of 47 procedures using a bioresorbable polycaprolactone based injectable for the treatment of mild to moderate stress urinary incontinence in adult females

“…The most used surgical intervention for female SUI is the Mid-Urethral Sling (MUS). 2 With the recent safety concerns and suggested underestimation of complications associated with MUS procedures, [3][4][5] there is a growing demand from both patients and physicians for less invasive treatment options with lower risk of complications. Moreover, when asking patients what they expect or prefer from a SUI treatment, this often differs from the physician's perception of success.…”

“…Whereas physicians often look for a long-term solution or cure, patients are often looking for minimally invasive procedures providing relief and reduced impact on their quality of life. [4][5][6] In this retrospective study we analyzed the effectiveness and safety of a new procedure for the treatment of mild-tomoderate SUI using a bioresorbable and collagen-stimulating injectable based on polycaprolactone. Moreover, we describe a small adjustment to the standard 3-point injection technique commonly used, which in our experience that enhances effectiveness.…”

Quality of life and sexual function after TVT surgery versus Bulkamid injection for primary stress urinary incontinence: 1 year results from a randomized clinical trial

“…However, mesh complications, such as erosion, obstruction and pain [8], have raised concerns, and in England the new NICE Guidelines advise that midurethral slings only be considered if other procedures are not suitable [9]. Furthermore, studies have shown that women are prepared to trade efficacy for safety by preferring a minimally invasive procedure [10,11].…”